Note: Use the "Print" button on your Web browser to print this page.

Membership Application

The Learning Disabilities Association of Virginia
(LDAV)

Please enroll me as a member in LDAV. 

(Membership fee includes National, State and local memberships.)      

Name:_____________________________________            



Street_______________________________________________ 

     

      _______________________________________________ 



City  ________________________ State____ZIP__________ 



Phone: ___-____-_____   



E-mail:___________________@____________________                             



I am a     ( ) New Member    ( ) Renewal              

           ( ) Parent        ( ) Professional         

           ( ) LD Adult      ( ) Friend               



I would( ) would not( ) like to work at the State or  

local level for LDAV.   

                              

____Enclosed are annual dues of $30.00 

 

____Enclosed is my additional contribution of $_______ 



Please make checks payable to LDAV and mail to:
LDAV

Randolph Towers, #505

4100 North 9th Street

Arlington, VA 22203


      
Dues and contributions may be treated as charitable 

contributions for Federal Income Tax purposes. 

      


    




    
      Thank you! 




  








 

 Contact Us • LDAV Home



©2001 Learning Disabilities Association of Virginia

All rights reserved.